Mini mental state Flashcards
main principles
- gain consent
- start with open questions
- conclude early if too distressing
-respond to distress with empathy - be curious
- ## report back findings to clinician in charge
general psychiatric assessment flow/
Introduction
History of Presenting Complaint
Past Psychiatric History
Family History
Personal History
Past Medical History
Use of Medication / Drugs / Alcohol
Forensic History
Mental State Examination
Relevant Physical Examination
Risk Assessment
history of presenting complaint q examples
What is the problem?
How long has it been like this?
What was happening when this started?
What make things worse? Or better?
NB May be difficult to identify starting point – Start of problems? Presentation to GP? Admission to ward?
Choose what seems relevant at the time
PAST PSYCHIATRIC HISTORY QS
“Have you ever had anything like this before?”
“Did you ever seek help for this in the past?”
“Have you ever been in hospital for this before”
“What treatments have you tried in the past?”
personal history qs
Birth
Early development
School - social / academic
Home environment
Qualifications
Relationships and children
Work
PMH qs
Medical Conditions
Admissions
Surgical Procedures
Head Injuries ?Accidents
Deliberate Self Harm
Medication, drugs and alcohol qs
Current Medication
Allergies
Illicit Drug use
How much?
What?
Alcohol Consumption
How much and how often?
How long?
questions to clarify alcohol and drug use
So what do you actually mean by social drinking?”
“Do you drink every day?”
“What age were you when you first started using drugs?”
“Have you ever injected? Which veins do you use?”
forensic history qs?
juvenile crime
court appearances
convictions
length of sentence
against person / property
experience of prison
what is the MSE
- Paints picture of what the patient is like at the time of assessment.
-Allows the doctor to make an accurate diagnosis and formulation.
main points of the MSE
Appearance and behaviour
Speech
Mood
Thoughts
Perceptions
Cognition
Insight
What to see in appearance
Appearance:
Build, dress
Hygiene
Evidence of self neglect
Evidence of self harm
Weight
Objects
What to see in behavior
Engagement, eye contact, tearfulness anxious
Are they socially appropriate or disinhibited
Are they agitated or distracted
Abnormal movements e.g. tremor
modifications for psychiatric exam/
important risks to consider
Self neglect
Harm to self
Suicide
Harm to others
Vulnerability to exploitation
Child risk
risk assesment?
How likely is it that an event will occur?
When is it expected to occur?
How bad will it be?
Aim is to develop a collaborative plan to reduce the risk and keep the plan under review
modifications for psychiatric exam?
Patient distressed
Patient has reduced cognitive/intellectual capacity
Non native speaker
Identification of urgent issues (medical/safeguarding/children)
Concerns about risk/safety issues
risk assesment?
How likely is it that an event will occur?
When is it expected to occur?
How bad will it be?
Aim is to develop a collaborative plan to reduce the risk and keep the plan under review
important risks to consider
Self neglect
Harm to self
Suicide
Harm to others
Vulnerability to exploitation
Child risk
important risks to consider
Self neglect
Harm to self
Suicide
Harm to others
Vulnerability to exploitation
Child risk
risk assesment?
How likely is it that an event will occur?
When is it expected to occur?
How bad will it be?
Aim is to develop a collaborative plan to reduce the risk and keep the plan under review
modifications for psychiatric exam?
Patient distressed
Patient has reduced cognitive/intellectual capacity
Non native speaker
Identification of urgent issues (medical/safeguarding/children)
Concerns about risk/safety issues
what can poor eye contact deduce
auditory hallucinations
Speech?
This is the production of speech rather than the content (under thoughts).
Rate e.g. rapid/ pressured (mania)
Rhythm and Tone e.g. monotonous (depression)
Volume e.g. loud, normal, soft
Mutism
neurological/organic signs
risk assesment?
How likely is it that an event will occur?
When is it expected to occur?
How bad will it be?
Aim is to develop a collaborative plan to reduce the risk and keep the plan under review
modifications for psychiatric exam?
Patient distressed
Patient has reduced cognitive/intellectual capacity
Non native speaker
Identification of urgent issues (medical/safeguarding/children)
Concerns about risk/safety issues
important risks to consider
Self neglect
Harm to self
Suicide
Harm to others
Vulnerability to exploitation
Child risk
Mood?
Mood -refers to emotion over a prolonged period of time.
subjective – patient’s view of their mood
objective – your assessment
euthymic
depressed or elated
irritable
Anxious
Affect - refers to immediate emotion
reactive
flat or blunted
incongruent
important risks to consider
Self neglect
Harm to self
Suicide
Harm to others
Vulnerability to exploitation
Child risk
Mood?
Mood -refers to emotion over a prolonged period of time.
subjective – patient’s view of their mood
objective – your assessment
euthymic
depressed or elated
irritable
Anxious
Affect - refers to immediate emotion
reactive
flat or blunted
incongruent
modifications for psychiatric exam?
Patient distressed
Patient has reduced cognitive/intellectual capacity
Non native speaker
Identification of urgent issues (medical/safeguarding/children)
Concerns about risk/safety issues
risk assesment?
How likely is it that an event will occur?
When is it expected to occur?
How bad will it be?
Aim is to develop a collaborative plan to reduce the risk and keep the plan under review
what are thougthts split into
-way thoughts linked together
- stream and form
-content of the thoughts themselves
what is stream in relation to thoughtsw
Stream - the amount and speed of thought
Pressure: unusually rapid, abundant and varied.
Poverty: unusually slow, few and unvaried.
Thought blocking: the mind is suddenly empty of thoughts. Can occur in paranoid Schizophrenia.
what is form
how well thoughts are linked
thought content ?
Delusions
Overvalued ideas
Obsessions
Thoughts of suicide/nihilistic thoughts
Thoughts of harm to others
define delusion
A false, unshakeable idea or belief that is firmly held despite evidence to the contrary that is not consistent with the person’s educational, cultural and social background.
types of delusions
-persecutory
-delusions of reference
-grandiose
- guilt or wortlessness
- delusions of contrtol
Thoughts of self harm or suicide
Thoughts of wishing to be dead
Fleeting suicidal thoughts
Thoughts without plans
Thoughts with plans
If plans what are they
What steps have been taken/planned
define illusion
Thoughts of wishing to be dead
Fleeting suicidal thoughts
Thoughts without plans
Thoughts with plans
If plans what are they
What steps have been taken/planned
define hallucinations
perception without an external stimulus
types of hallucinations
2nd person auditory hallucinations – voices talk to the patient
3rd person auditory hallucinations – voices talking about the patient.
Command hallucinations - voices telling the person to do something
define derealisation
feeling the world is not real
depersonalisation?
feeling detached from yourself and emotions
cognition?
This refers to a person’s current capacity to process information.
Comment on
Level of consciousness
Orientation to time and place
Ability to engage with the assessment and take on new information.
what is insight
The patient’s awareness and understanding of their mental illness, it takes into account –
